C HAPTER 24: T RAUMA
Urden: Priorities in Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. A patient is admitted to the ICU for observation of his grade II splenic
laceration. Which signs and symptoms suggest that the patient has had a
delayed rupture of his splenic capsule and is now in hemorrhagic shock?
a. BP, 110/70 mm Hg; HR , 120 beats/min; Hct, 42 mg/dL; UO, 40
mL/hr; skin that is pink, warm, and dry with capillary refill of 3
seconds
b. BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10
mL/hr; pale, cool, clamm y skin; confused
c. BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 3 5 mg/dL; UO, 30
mL/hr; pale, cool, dry skin; alert and oriented
d. BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60
mL/hr; flushed, warm, diaphoretic skin; agitated and confused
ANS: B
The first set of vital signs is normal. Patients who are in he morrhagic
shock are significantly tachycardic with a narrowed pulse pressure and
oliguric, and their skin is pale, cool, and clamm y. They also have a low
hematocrit and are confused.
Hemodynamicall y stable patients may be monitored in the critical care
unit by means of serial hematocrit values and vital signs. Progressive
deterioration may indicate the need for operative management.
, PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Trauma MSC:
NCLEX: Physiological Integrit y: Physiological Adaptation
2. A patient with multisystem trauma has been in the ICU for 6 days. The
patient is still intubated and mechanicall y ventilated and has a chest
tube, urinary drainage catheter, nasogastric tube, and two abdominal
drains. The patient’s vital signs include: BP —92/66 mm Hg; HR—118
beats/min; T—38.7°C; and CVP —5 mm Hg. What is the most likel y
cause of this hemodynamic picture?
a. Septic shock
b. Hemorrhagic shock
c. Cardiogenic shock
d. Neurogenic shock
ANS: A
The patient with multiple i njuries is at risk for overwhelming
infections and sepsis. The source of sepsis in the trauma patient can be
invasive therapeutic and diagnostic catheters or wound contamination
with exogenous or endogenous bacteria. The source of the septic nidus
must be promptl y evaluated. Gram stain and cultures of blood, urine,
sputum, invasive catheters, and wounds are obtained.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Diagnosis TOP: Trauma MSC:
NCLEX: Physiological Integrit y: Physiol ogical Adaptation
, 3. Older trauma patients have a higher mortalit y than younger trauma
patients. The nurse understands that this fact is probabl y related to what
physiologic change?
a. Deterioration of cerebral and motor skills
b. Poor vision and hearing
c. Diminished pain perception
d. Limited physiologic reserve
ANS: D
Older adults have limited abilit y to increase their heart rate in response
to blood loss, obscuring one of the earliest signs of hypovolemia —
tachycardia. Loss of physiologic reserve and the presence o f
preexisting medical conditions are likel y to produce further conflicting
hemodynamic data. An older patient’s lack of physiologic reserve
makes it imperative that earl y nutritional support is initiated.
PTS: 1 DIF: Cognitive Level: Understanding OBJ:
Nursing Process Step: Assessment TOP: Trauma
MSC: NC LEX: Physiological Integrit y: Physiological
Adaptation
4. The nurse is working on an organization -wide falls prevention project.
The nurse understands that the majorit y of falls accounting for traumati c
injury occur in what population?
a. Construction workers
b. Adolescents
c. Older adults
d. Young adults
Urden: Priorities in Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. A patient is admitted to the ICU for observation of his grade II splenic
laceration. Which signs and symptoms suggest that the patient has had a
delayed rupture of his splenic capsule and is now in hemorrhagic shock?
a. BP, 110/70 mm Hg; HR , 120 beats/min; Hct, 42 mg/dL; UO, 40
mL/hr; skin that is pink, warm, and dry with capillary refill of 3
seconds
b. BP, 90/70 mm Hg; HR, 140 beats/min; Hct, 21 mg/dL; UO, 10
mL/hr; pale, cool, clamm y skin; confused
c. BP, 100/60 mm Hg; HR, 100 beats/min; Hct, 3 5 mg/dL; UO, 30
mL/hr; pale, cool, dry skin; alert and oriented
d. BP, 110/60 mm Hg; HR, 118 beats/min; Hct, 38 mg/dL; UO, 60
mL/hr; flushed, warm, diaphoretic skin; agitated and confused
ANS: B
The first set of vital signs is normal. Patients who are in he morrhagic
shock are significantly tachycardic with a narrowed pulse pressure and
oliguric, and their skin is pale, cool, and clamm y. They also have a low
hematocrit and are confused.
Hemodynamicall y stable patients may be monitored in the critical care
unit by means of serial hematocrit values and vital signs. Progressive
deterioration may indicate the need for operative management.
, PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Assessment TOP: Trauma MSC:
NCLEX: Physiological Integrit y: Physiological Adaptation
2. A patient with multisystem trauma has been in the ICU for 6 days. The
patient is still intubated and mechanicall y ventilated and has a chest
tube, urinary drainage catheter, nasogastric tube, and two abdominal
drains. The patient’s vital signs include: BP —92/66 mm Hg; HR—118
beats/min; T—38.7°C; and CVP —5 mm Hg. What is the most likel y
cause of this hemodynamic picture?
a. Septic shock
b. Hemorrhagic shock
c. Cardiogenic shock
d. Neurogenic shock
ANS: A
The patient with multiple i njuries is at risk for overwhelming
infections and sepsis. The source of sepsis in the trauma patient can be
invasive therapeutic and diagnostic catheters or wound contamination
with exogenous or endogenous bacteria. The source of the septic nidus
must be promptl y evaluated. Gram stain and cultures of blood, urine,
sputum, invasive catheters, and wounds are obtained.
PTS: 1 DIF: Cognitive Level: Anal yzing OBJ: Nursing
Process Step: Diagnosis TOP: Trauma MSC:
NCLEX: Physiological Integrit y: Physiol ogical Adaptation
, 3. Older trauma patients have a higher mortalit y than younger trauma
patients. The nurse understands that this fact is probabl y related to what
physiologic change?
a. Deterioration of cerebral and motor skills
b. Poor vision and hearing
c. Diminished pain perception
d. Limited physiologic reserve
ANS: D
Older adults have limited abilit y to increase their heart rate in response
to blood loss, obscuring one of the earliest signs of hypovolemia —
tachycardia. Loss of physiologic reserve and the presence o f
preexisting medical conditions are likel y to produce further conflicting
hemodynamic data. An older patient’s lack of physiologic reserve
makes it imperative that earl y nutritional support is initiated.
PTS: 1 DIF: Cognitive Level: Understanding OBJ:
Nursing Process Step: Assessment TOP: Trauma
MSC: NC LEX: Physiological Integrit y: Physiological
Adaptation
4. The nurse is working on an organization -wide falls prevention project.
The nurse understands that the majorit y of falls accounting for traumati c
injury occur in what population?
a. Construction workers
b. Adolescents
c. Older adults
d. Young adults
